Pessary



Dec. 29, 1953 Filed March 15. 1948 w. J. HEUBOSKI ETAL 2,664,082

PESSARY 2 Sheets-Sheet 1 INVENTOR. WaJZerJl-leubasli and iymen T7721: ram

W. J. HEUBOSKI ET AL Dec. 29, 1953 PESSARY 2 Sheets-Sheet 2 Filed March 15. 1948 INVENTOR. Walter J Heuboski and y hymen T/hi? rem Patented Dec. 29, 195 3 UNITED STATES: PATENT OFFICE PESSARY Walter J. Heuboslri and Hymen T. Milgrom,

Chicago, Ill.

Application March 15, 1948, Serial No. 14,916

The core of one common type of pessary consists of an endless coiled wire spring ring. Such a pessary often does not afford adequate support lor the vaginal walls, and is often unsatisfactory for insertion into the vaginal canal, because,

when folded for insertion, its rim lies essentially H in a single plane, making it unwieldy to insert by hand and diflicult, due to its yieldability upon meeting an obstruction, forthe posterior end of the rim to enter the canal and to pass up into the cul-de-sac behind the cervix when, as is often the case, the cervix is found to be substantially in contact with the vaginal wall; and it is often diificult for the anterior end of the rim to pass up into and to be retained in the pubic notch.

Attempts have been made to overcome the foregoing drawbacks, but they have been unsatisfactory for the following, among other, reasons. These attempts have followed more or less the pattern of making the core in such form that, when held by the hand in folded condition for insertion, the core takes the shape of a doubled bow or arch. These are of two general types. In one such type, the core is relatively stiff except at two highly localized diametrically opposite points, where they are made resilient, so that, when folded at such points, the doubled rim is bowed. or arched and is more readily fitted into the cul-de-sac and pubic notch above referred to. This type of pessary lacks an important characteristic of the core it is intended to improve, namely, the ability to be stretched easily and sprung onto an inserting instrument such as is used by a woman too corpulent or for any other reason unable to properly insert the pessary by hand. Examples of such instruments areshown on page 198 of Control or Conception by Robert L. Dickinson, 2nd Ed, 1938, published by Williams & Wilkins, Baltimore, Maryland. Moreover, such a pessary, due to the highly localized flexible hinge points, bends too sharply thereat, thereby requiring considerable pinching force with concomitant fatiguing of the core material affected, with the result that the affected material may before long take a permanent set or otherwise deteriorate, so that the effective ,life

4 Claims. (Cl. l 28127) of the article is relatively quite limited. Where the affected core material so localized ismetal, moreover, there is danger of its breaking off and puncturing the rubber, latex or other coat or covering, with possible injury to the delicate tissues of the woman. Furthermore, the relatively still portions in one form of this type are of hard rubber and therefore subject to breakage or cracking, and are thermoplastic so that they tend to get out of shape when boiled to sterilize the pessary. In the other such type, the core is made of completely circular coiled springs or a circular piece of elastic rubber, each in the shape of a hollow frustum of a cone. This type will bow when folded, but is so highly yieldable thatit has the objectionable characteristic of the-single spring type with respect to obstructions, requires a special type of inserting instrument to accommodate it, is too read ly yieldable to give the necessary support at the anterior and posterior walls of the vagina, and,. as to the multiple-spring form, is relatively expensive to manufacture.

Objects of our invention are to provide pessaries free of certain or all of the above noted disadvantages.

In a common process of moding rubber to a metal pessary core such as a coiled spring ring,

the core'rests on, a mold surface so that a circular series of points at the bottom of the core remainsuncoated. When the core thus treated is removed from the mold, the operator must coat the entire bare bottom of the core with cement and subsequently with latex or the like, by spraying or otherwise.

To provide a core with which the amount of coating work after the completion of the molding operation is substantially reduced is accordingly another object of our invention.

Further'objects and advantages of the invention will appear as the description proceeds.

The invention will be better understood upon reference to the following description and accompanying drawings, wherein;

Fig. 1 is a plan view of a life size hand-inserted type of ring pessary or the rim of a handinserted. diaphragm pessary, with portions removed to reveal parts of the core, constructed in accordance with one form of our invention.

. Fig. 2 is a plan view of such a diaphragm pessary.

Fig. 3 is an edge elevational view showing the diaphragm indash-dot lines.

Fig. 4 is a top plan view of the same diaphragm pessary in folded condition as it is held by the thumb and forefinger preparatory to and during insertion into the vaginal canal.

Fig. 5 is an elevational view of the folded diaphragm pessary shown in Fig. 4.

Fig. 6 is a view taken as indicated by the line 6-6 in Fig. 5.

Fig. '7 is an enlarged fragmentary sectional view taken as indicated by the line 1-1 in Fig. 1.

Fig. 8 is an enlarged fragmentary sectional view showing a portion of the molded core in a mold.

Fig. 9 is a sectional view taken as indicated by the line 9--9 in Fig. 8.

Fig. 10 is a plan view of the core and part of the rubber covering therefor of an instrumentinserted pessary constructed in accordance with one form of our invention.

Fig. 11 is a life size elevational view showing a pessary of the instrument-inserted type stretched and sprung onto an inserting instrument.

Fig. 12 is a fragmentary plan view of the same.

Fig. 13 shows the proper position occupied by any diaphragm pessary of our invention in the vaginal canal.

Fig. 14 is a fragmentary enlarged longitudinal elevational view, partly in section, showing a modified connection between each core spring and each core rod.

Fig. 15 is a sectional plan view taken as indicated by the line |5l5 in Fig. 14.

Fig. 16 is a transverse sectional view taken as indicated by the line 6-1 6 in Fig. 14.

Referring now more particularly to the drawings, there is shown generally at 20 a pessary core constructed in accordance with one form of our invention. It comprises four arcuate segments, two opposite segments 22 being formed of rigid, preferably unpliable metal such as steel or other suitable rod stock and the other two 0pposite segments 24 being formed of coiled spring wire such as piano wire, with the coils preferably close together but spaced apart. Each rod 22 is spotted at 26 by colored latex, rubber or otherwise to draw attention to its center, for a reason which will appear. The ends 28 of each rod 22 are telescoped, preferably with a tight friction fit, a substantial distance into the end portions 30 of the springs 24. Solder, cement or other suitable bonding material 32 may be applied to the spring ends 30 and associated rod ends 28 to substantially integrally join them and thus form a unitary ring whose axis is planar, or crimping may be resorted to for that purpose. The solder 32 or the like, when solid, or the crimped parts of the spring, as the case may be, preferably do not project radially outward substantially beyond the cylindrical envelope of the coils proper.

The diameter of the rod stock is preferably less than the outside diameter of the spring coils, so that, when the core 20 rests on the surface 34 of a mold 36 used in molding rubber 38 to the core (and, if a diaphragm pessary is being made, in also molding a domed membrane or diaphragm 40 to the core-covering rubber), the'portions 42 of the rods or shanks 22 between the springs 24 will be elevated from the mold surface, as shown at 44, enabling the rubber to completely surround the elevated portions, leaving bare only pin-point portions 46 of the bottoms of the coils. Latex may tend to peel from an uninterrupted smooth surface such as that of the rod stock, but will readily and securely adhere to rubber and to pin-point areas surrounded by rubber, the latex being applied by spraying or in any other suitable fashion, preferably after a coat of cement has been applied. Latex may be ap- 4 plied at the same time to the rubber covered bottoms of the rods, preferably after a coat of cement has been applied, to build the same up somewhat if desired.

If rod stock of the same outside diameter as the inside diameter of the coil springs and of the requisite strength and rigidity is available at the same or less cost than the shouldered rods above described and illustrated in the drawings, its use may be desirable. The shouldered rods, however, afford the advantage of preventing excessive projection of one end of each rod into the cooperating spring and thus reducing to some extent the time necessary to properly assemble the springs and rods to form a core.

The tips of the rods may be tapered or rounded as indicated at 50 to facilitate introduction into the springs.

The use of bonding material may be obviated by compressing or crimping the telescoped portions of the springs 24 and rods 22, as shown in Figs. 14, 15 and 16. They need be compressed only a very slight distance, reducing the thickness by a small amount, the pressure being preferably applied in directions normal to the plane of the core axis, portions of the rod ends flowing into the spaces between successive coils as shown at 54.

To form a ring pessary, shown in Fig. 1, we follow the same procedure as that above described, but of course omit the membrance 40, and this is taken care of by the mold used in such case.

When our hand-inserted type of pessary is folded (by the thumb and finger) preparatory to insertion into the vaginal canal, with the rods close together, as shown in Figs. 4 and 5, each spring is flexed into U-shape, as shown in Figs. 4 and 6, but its arms 60 are not excessively long, and the rim 62 in thus being doubled assumes a bowed or arched shape which will enable it to adapt itself and comfortably and adequately conform to the vaginal anatomy and which will enable the posterior end, for example the end 64, of the rim to be readily forced into the vaginal canal 66 and to readily enter the cul-de-sac 68 behind the cervix 10, displacing a portion of the lower side 12 of the vaginal wall 14 if such portion happens to be substantially in contact with the cervix. Either folded spring end of the rim may serve as the posterior end of the pessary. When the pessary is released, its sides ar moved away from each other by the springs against the soft sides of the vaginal wall 14 until the rim 62 is approximately in the form of a, fairly wide oval, but still very substantially bowed. The anterior end 16 of the rim 62 is then substantially below the pubic notch 18. The woman then inserts her finger under and raises the anterior end 16 of the rim 62 until the entire rim reverses itself by spring action, toggle fashion, and assumes the reversed bowed shape shown in Fig. 13, the posterior end 64 of the rim moving up into the culde-sac 68 to take a position behind the cervix l0 and the anterior end of the rim projecting upward. She then makes sure that the anterior end 16 of the rim 62 projects into the pubic notch, manipulating such end for that purpose if necessary.

If the springs were substantially longer than the rods in the hand-inserted form of our pessary, the posterior spring, upon engagement with the obstruction offered by the anterior -end .of the canal, and also that offered by the cervix 10 when substantially in contact with the lower side of the vaginal wall, would flex backward and upward pivotally "relative to the adjacent ends of the rods as the sides of the 'pessarymove further toward and within the vagina. In the hand-inserted form of our invention, the effective portion 84 of each spring, i. -e., the portion beyond the rods, is sufiicientlyshort, measured along the major axis of the folded rim, to have adequate stiffness, when in its U-shape pursuant to the folding of the rim, to be forced intoand readily enter the canal and proceed :to the 'culde-sac behind the cervix, yet is of ample length to arc easily into the U-shape without being stressed beyond the elastic limit, so "that the springs are not subject to fatigue with continued use.

In the instrument-inserted form of our invention, shown at 90 in Figs. l0,'l'1 and 12, the 'core, generally indicated at 92, is so constructed that the effective portion of each spring 94 is substantially greater than the length of each associated rod 96, so that the rim 98 is capable, by reason of the effective lengths of such springs, of being stretched sufficiently to be sprung and slipped readily onto an inserting instrument, of which one well-known type is shown at I00, to facilitate insertion into the canal and insure passage into the cul-de-sac behind the cervix. The rod 96 insure the rims assuming an arched or bowed shape when within the canal, because, 1

when there located, the walls of the canal prevent the rim from returning to its original circular shape and operate to maintain it in a fairly wide but definitely oval shape. In use,

when this pessary is placed on the instrument,

the pessary should be bowed downward as shown in Fig. 11, and when it is inserted as far as it should. go within the canal, it is released from the instrument, as by using a finger or'thumb to lift the anterior end Hi2 of the rim off that instrument hook iM by which it is held, whereupon the pessary rim assumes an oval bowed form in contact with the vaginal walls as may be noted from Fig. 13. Then the woman or physician makes sure, by finger manipulation if necessary, that the anterior end I02 of the rim S8 is located in the pubic notch 18.

The core-covering rubber and latex are transparent, at least sufficiently to render the spotting 26 clearly visible and conspicuous, so that the user will know at once where to apply the thumb and finger to pinch the rim of the pessary to fold it either for hand insertion or for springing it onto the instrument.

The bulk of diaphragm pessaries sold are made in sizes of 60, 65, 70, 75, 80, 85 and 90 millimeters axis diameter. Satisfactory results with the hand-inserted type of ring and pessary of our invention may be obtained by using rods varying in over-all arcuate length from 1%" for the 60 millimeter pessary to 3% for the 90 millimeter pessary, varying pregressively A" for each change of millimeters in pessary size. In such pessaries, the angle subtended by each rod varies from about for the 1%" rod millimeter pessary) to about 105 for the 3%" rod (90 millimeter pessary), and of course the angle subtended by the effective portion of each spring (i. e., the portion between the ends of the rods to which such spring is joined), being complementary to the subtended by the associated rod, varies from about 95 for the 60 millimeter pessary to about 75 for the 90 millimeter pessary. For the 55- and 95-mil1imeter hand-inserted pesseries, which are occasionally calledfor, l

and "3%" rods, respectively, would be suitable.

with the instrument-introduced type of pessary of our invention, satisfactory results may be obtainedby usingrocls varying in over-all arcuate length from 1 for the 60 millimeter pessary to 1% for the '90 millimeter pessary. The different sizes of rod could vary in equal steps, but, in order to avoid the inconvenience and possible confusion which-might flow from the 'use of seven'different sizes varying successively by increments of is", we find it expedient and satisfactoryto employ 1%" rods for the 70,

75 "and millimeter pessaries, and 1%" rods for the 8 5and millimeter pessaries. For the 55 and millimeter pessaries, 1%, and 1% rods, respectively, would be suitable.

Satisfactory results are obtained by making the-reduced ends of the rods about' fii" long and telescoping them tightly substantially throughout their lengths into the ends of the springs. If made substantially shorter, the rod ends may have insuflicient bearing engagement with the springs to insure supporting the rods with their axes coplanar with the axes of the springs while the rod ends and springs are being soldered together or otherwise united. It is advisable to make the surface of-each rod end rough where it engages the inner surface of the spring.

The foregoing rod dimensions may be varied somewhat without seriously affecting the ease of introduction or efficacy to the pessaries involved. Care should be taken with regard to the 'hand inserted type that, when the pessary is folded preparatory to insertion, the arms of the 'U formed by the effective portion of each spring are not of excessive length. Otherwise, the posterior folded spring will be too readily flexible pivotally about the junctures thereof with the rods in a direction to deepen the bow, when the bight of the spring engages the obstruction offered by the anterior end of the canal and also that offeredby the vaginal wall when too close to the cervix, thus making the insertion by hand difficult, as noted above. This would oc our, for example, if an attempt were made to insert our instrument-inserted type of pessary by hand. The proportions shown and resulting from the relative dimensions given above have been found satisfactory, affording folded spring ends which will yield to an extent precluding injury to any part of the canal or cervix and yet have a .degree of rigidity which, in the handinserted type, will insure ready introduction and entrance of the pessary and passage of the pos terior end of the pessary into the cul-de-sac behind the cervix, even when the cervix is close to or in contact with the wall of the canal.

Care should be taken, with regard to the instrument-inserted pessary, that the effective spring length is ample to insure that the pessary rim will stretch and elongate sufficiently to be sprung onto and retain itself on and will not accidentally snap off the instrument, and care should at the same time be taken that the rods are of sufficient length to insure that, when the pessary is properly positioned within the canal, it assumes a bowed shape as indicated in Fig. 13, for the purpose noted above. Although the springs of the instrument-inserted pessary are relatively too long and therefore too readily yieldable to be suitable for hand insertion, they are quite suitable for instrument insertion since the instrument supports the pessary in such manner as to preclude undesired flexing of the entering or posterior spring, yet will readily give in the direction of its minor axis to enable the rod portions of the rim, while supported on the instrument, to approach each other sufficiently to enter the canal.

As has been noted, all of the rods are preferably of rod stock which is unpliable by hand so that it will not get out of shape in service, and may be produced by automatic screw machines in straight form and then machine-bent to the desired curvature. They are preferably made of stainless or other steel or other metal, or other suitable material. The reduced ends of each rod are preferably coaxial with the remainder of the rod and have ample bearing engagement with the springs, notwithstanding manufacturing tolerances as a result of which one or more of the springs may not quite touch a rod shoulder or shoulders in some instances, and will not accidentally spring apart before being united with the springs by solder, crimping or otherwise. Thus when the core rests on the bottom of the mold and receives a covering of resilient rubber, the rods will be elevated from the bottom of the mold by virtue of the fact that the outside diameter of the spring coils is slightly greater than that of the rods. We have found it satisfactory for our purposes to use a spring coil diameter of A" and a rod stock diameter of so that the rods are elevated from the mold bottom and receive a molded covering of rubber which, at the bottoms of the rods, are 4 thick. However, the relative cross-sectional dimensions of the springs and rods obviously may be varied to obtain any desired rim diameters and any desired thickness of molded rubber coating at the bottom of the rods. Indeed, if desired, the diameters of the springs and rods could be identical, or the rods could be of greater diameter than the coils, although such arrangements may introduce the necessity for a certain extra amount of latex coating at the bottoms of the rods which is obviated if the rods are diametrally smaller than the springs as noted above.

The springs are normally straight and the rods, when about to be assembled with the springs, are curved. In assembling the rods with the springs, which is readily done by hand, an end of each rod may be forced into an end of a spring, and these three elements as a unit are flexed (at the spring, of course) as is also the other spring, to the requisite extent, whereupon the remaining rod ends are forced into the ends of the other spring, and thereupon is completed a circular core with its axis in a single plane.

Although we have illustrated the springs and rods as being round in cross-section, other shapes which may be found suitable may be employed if desired.

Various changes coming within the spirit of our invention may suggest themselves to those skilled in the art; hence we do not wish to be restricted to the forms shown or uses mentioned except to the extent indicated by the appended claims.

We claim:

1. An annular pessary core including a pair of coil spring segments and a pair of relatively substantially stiffer segments connected alternately with said spring segments in substantially end-to-end relation, each of said stiffer segments comprising a rod with end portions telescoped Within the adjacent end portions of said spring segments, each rod segment being enlarged substantially throughout its length between said spring segments.

2. In a foldable pessary, an annular core including a pair of spring segments and a pair of unpliable segments connected alternately with said spring segments substantially in end-to-end relation, non-metallic resilient soft means hermetically and intimately covering said core, and indicating means disposed on and substantially midway of the length of each unpliable segment and visible through said covering means to indicate the places at which the fingers should apply pressure for properly folding the pessary.

3. An annular pessary core including a pair of spring segments and a pair of relatively substantially stiffer segments connected alternately with said spring segments in substantially end-to-end relation, said spring segments comprising coils of uniform diameter, said stiffer segments comprising rods whose end portions are telescoped within the end portions of said spring segments, each rod being enlarged substantially throughout its length between said spring segments, the diameter of the enlarged portions of said rods being less than the outside diameter of said coils, whereby, when said spring segments rest on a level surface, said rods are elevated above such surface.

4. A ring-like pessary core having a pair of wire spring coil portions which are rectilinear when free, and a pair of relatively stifi elongated portions alternating with said coil portions, each elongated portion having reduced terminals telescoped substantially throughout their lengths Within the ends of said coil portions and soldered thereto, each of said coil portions projecting beyond the space defined by the outer planes of said elongated portions.

WALTER J. HEUBOSKI. HYMEN T. MILGROM.

References Cited in the file of this patent UNITED STATES PATENTS Number Name Date 1,949,863 Hay Mar. 6, 1934 2,123,148 Findley July 5, 1938 2,443,943 Young June 22, 1948 FOREIGN PATENTS Number Country Date 117,023 Australia May 24, 1943 352,865 Germany May 6, 1922 

